Printed educational messages fail to increase use of thiazides as first-line medication for hypertension in primary care

a cluster randomized controlled trial [ISRCTN72772651]

Merrick Zwarenstein (Corresponding Author), Jeremy M Grimshaw, Justin Presseau, Jill J Francis, Gaston Godin, Marie Johnston, Martin P Eccles, Jacqueline Tetroe, Susan K Shiller, Ruth Croxford, Diane Kelsall, J Michael Paterson, Peter C Austin, Karen Tu, Lingsong Yun, Janet E Hux

Research output: Contribution to journalArticle

4 Citations (Scopus)
4 Downloads (Pure)

Abstract

BACKGROUND: Evidence on the effectiveness of printed educational messages in contributing to increasing evidence-based clinical practice is contradictory. Nonetheless, these messages flood physician offices, in an attempt to promote treatments that can reduce costs while improving patient outcomes. This study evaluated the ability of printed educational messages to promote the choice of thiazides as the first-line treatment for individuals newly diagnosed with hypertension, a practice supported by good evidence and included in guidelines, and one which could reduce costs to the health care system.

METHODS: The study uses a pragmatic, cluster randomized controlled trial (randomized by physician practice group).

SETTING: The setting involves all Ontario general/family practice physicians. Messages advising the use of thiazides as the first-line treatment of hypertension were mailed to each physician in conjunction with a widely read professional newsletter. Physicians were randomized to receive differing versions of printed educational messages: an "insert" (two-page evidence-based article) and/or one of two different versions of an "outsert" (short, directive message stapled to the outside of the newsletter). One outsert was developed without an explicit theory and one with messages developed targeting factors from the theory of planned behaviour or neither (newsletter only, with no mention of thiazides). The percentage of patients aged over 65 and newly diagnosed with hypertension who were prescribed a thiazide as the sole initial prescription medication. The effect of the intervention was estimated using a logistic regression model estimated using generalized estimating equation methods to account for the clustering of patients within physician practices.

RESULTS: Four thousand five hundred four physicians (with 23,508 patients) were randomized, providing 97 % power to detect a 5 % absolute increase in prescription of thiazides. No intervention effect was detected. Thiazides were prescribed to 27.6 % of the patients who saw control physicians, 27.4 % for the insert, 26.8 % for the outsert and 28.3 % of the patients who saw insert + outsert physicians, p = 0.54.

CONCLUSIONS: The study conclusively failed to demonstrate any impact of the printed educational messages on increasing prescribing of thiazide diuretics for first-line management of hypertension.

TRIAL REGISTRATION: ISRCTN72772651.

Original languageEnglish
Article number124
JournalImplementation Science
Volume11
Issue number1
DOIs
Publication statusPublished - 17 Sep 2016

Fingerprint

Thiazides
Primary Health Care
Randomized Controlled Trials
Hypertension
Physicians
Prescriptions
Logistic Models
Sodium Chloride Symporter Inhibitors
Costs and Cost Analysis
Physicians' Offices
Family Practice
Evidence-Based Practice
Family Physicians
Ontario
General Practitioners
Cluster Analysis
Therapeutics
Guidelines
Delivery of Health Care

Cite this

Printed educational messages fail to increase use of thiazides as first-line medication for hypertension in primary care : a cluster randomized controlled trial [ISRCTN72772651]. / Zwarenstein, Merrick (Corresponding Author); Grimshaw, Jeremy M; Presseau, Justin; Francis, Jill J; Godin, Gaston; Johnston, Marie; Eccles, Martin P; Tetroe, Jacqueline; Shiller, Susan K; Croxford, Ruth; Kelsall, Diane; Paterson, J Michael; Austin, Peter C; Tu, Karen; Yun, Lingsong; Hux, Janet E.

In: Implementation Science, Vol. 11, No. 1, 124, 17.09.2016.

Research output: Contribution to journalArticle

Zwarenstein, M, Grimshaw, JM, Presseau, J, Francis, JJ, Godin, G, Johnston, M, Eccles, MP, Tetroe, J, Shiller, SK, Croxford, R, Kelsall, D, Paterson, JM, Austin, PC, Tu, K, Yun, L & Hux, JE 2016, 'Printed educational messages fail to increase use of thiazides as first-line medication for hypertension in primary care: a cluster randomized controlled trial [ISRCTN72772651]', Implementation Science, vol. 11, no. 1, 124. https://doi.org/10.1186/s13012-016-0486-3
Zwarenstein, Merrick ; Grimshaw, Jeremy M ; Presseau, Justin ; Francis, Jill J ; Godin, Gaston ; Johnston, Marie ; Eccles, Martin P ; Tetroe, Jacqueline ; Shiller, Susan K ; Croxford, Ruth ; Kelsall, Diane ; Paterson, J Michael ; Austin, Peter C ; Tu, Karen ; Yun, Lingsong ; Hux, Janet E. / Printed educational messages fail to increase use of thiazides as first-line medication for hypertension in primary care : a cluster randomized controlled trial [ISRCTN72772651]. In: Implementation Science. 2016 ; Vol. 11, No. 1.
@article{e976e8a4238a46abb9162ead8571a9d5,
title = "Printed educational messages fail to increase use of thiazides as first-line medication for hypertension in primary care: a cluster randomized controlled trial [ISRCTN72772651]",
abstract = "BACKGROUND: Evidence on the effectiveness of printed educational messages in contributing to increasing evidence-based clinical practice is contradictory. Nonetheless, these messages flood physician offices, in an attempt to promote treatments that can reduce costs while improving patient outcomes. This study evaluated the ability of printed educational messages to promote the choice of thiazides as the first-line treatment for individuals newly diagnosed with hypertension, a practice supported by good evidence and included in guidelines, and one which could reduce costs to the health care system.METHODS: The study uses a pragmatic, cluster randomized controlled trial (randomized by physician practice group).SETTING: The setting involves all Ontario general/family practice physicians. Messages advising the use of thiazides as the first-line treatment of hypertension were mailed to each physician in conjunction with a widely read professional newsletter. Physicians were randomized to receive differing versions of printed educational messages: an {"}insert{"} (two-page evidence-based article) and/or one of two different versions of an {"}outsert{"} (short, directive message stapled to the outside of the newsletter). One outsert was developed without an explicit theory and one with messages developed targeting factors from the theory of planned behaviour or neither (newsletter only, with no mention of thiazides). The percentage of patients aged over 65 and newly diagnosed with hypertension who were prescribed a thiazide as the sole initial prescription medication. The effect of the intervention was estimated using a logistic regression model estimated using generalized estimating equation methods to account for the clustering of patients within physician practices.RESULTS: Four thousand five hundred four physicians (with 23,508 patients) were randomized, providing 97 {\%} power to detect a 5 {\%} absolute increase in prescription of thiazides. No intervention effect was detected. Thiazides were prescribed to 27.6 {\%} of the patients who saw control physicians, 27.4 {\%} for the insert, 26.8 {\%} for the outsert and 28.3 {\%} of the patients who saw insert + outsert physicians, p = 0.54.CONCLUSIONS: The study conclusively failed to demonstrate any impact of the printed educational messages on increasing prescribing of thiazide diuretics for first-line management of hypertension.TRIAL REGISTRATION: ISRCTN72772651.",
author = "Merrick Zwarenstein and Grimshaw, {Jeremy M} and Justin Presseau and Francis, {Jill J} and Gaston Godin and Marie Johnston and Eccles, {Martin P} and Jacqueline Tetroe and Shiller, {Susan K} and Ruth Croxford and Diane Kelsall and Paterson, {J Michael} and Austin, {Peter C} and Karen Tu and Lingsong Yun and Hux, {Janet E}",
note = "Funding (Canadian Institutes of Health Research, award number 724180703) The Canadian Institutes of Health Research had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or in the preparation, review or approval of the manuscript.",
year = "2016",
month = "9",
day = "17",
doi = "10.1186/s13012-016-0486-3",
language = "English",
volume = "11",
journal = "Implementation Science",
issn = "1748-5908",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Printed educational messages fail to increase use of thiazides as first-line medication for hypertension in primary care

T2 - a cluster randomized controlled trial [ISRCTN72772651]

AU - Zwarenstein, Merrick

AU - Grimshaw, Jeremy M

AU - Presseau, Justin

AU - Francis, Jill J

AU - Godin, Gaston

AU - Johnston, Marie

AU - Eccles, Martin P

AU - Tetroe, Jacqueline

AU - Shiller, Susan K

AU - Croxford, Ruth

AU - Kelsall, Diane

AU - Paterson, J Michael

AU - Austin, Peter C

AU - Tu, Karen

AU - Yun, Lingsong

AU - Hux, Janet E

N1 - Funding (Canadian Institutes of Health Research, award number 724180703) The Canadian Institutes of Health Research had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; or in the preparation, review or approval of the manuscript.

PY - 2016/9/17

Y1 - 2016/9/17

N2 - BACKGROUND: Evidence on the effectiveness of printed educational messages in contributing to increasing evidence-based clinical practice is contradictory. Nonetheless, these messages flood physician offices, in an attempt to promote treatments that can reduce costs while improving patient outcomes. This study evaluated the ability of printed educational messages to promote the choice of thiazides as the first-line treatment for individuals newly diagnosed with hypertension, a practice supported by good evidence and included in guidelines, and one which could reduce costs to the health care system.METHODS: The study uses a pragmatic, cluster randomized controlled trial (randomized by physician practice group).SETTING: The setting involves all Ontario general/family practice physicians. Messages advising the use of thiazides as the first-line treatment of hypertension were mailed to each physician in conjunction with a widely read professional newsletter. Physicians were randomized to receive differing versions of printed educational messages: an "insert" (two-page evidence-based article) and/or one of two different versions of an "outsert" (short, directive message stapled to the outside of the newsletter). One outsert was developed without an explicit theory and one with messages developed targeting factors from the theory of planned behaviour or neither (newsletter only, with no mention of thiazides). The percentage of patients aged over 65 and newly diagnosed with hypertension who were prescribed a thiazide as the sole initial prescription medication. The effect of the intervention was estimated using a logistic regression model estimated using generalized estimating equation methods to account for the clustering of patients within physician practices.RESULTS: Four thousand five hundred four physicians (with 23,508 patients) were randomized, providing 97 % power to detect a 5 % absolute increase in prescription of thiazides. No intervention effect was detected. Thiazides were prescribed to 27.6 % of the patients who saw control physicians, 27.4 % for the insert, 26.8 % for the outsert and 28.3 % of the patients who saw insert + outsert physicians, p = 0.54.CONCLUSIONS: The study conclusively failed to demonstrate any impact of the printed educational messages on increasing prescribing of thiazide diuretics for first-line management of hypertension.TRIAL REGISTRATION: ISRCTN72772651.

AB - BACKGROUND: Evidence on the effectiveness of printed educational messages in contributing to increasing evidence-based clinical practice is contradictory. Nonetheless, these messages flood physician offices, in an attempt to promote treatments that can reduce costs while improving patient outcomes. This study evaluated the ability of printed educational messages to promote the choice of thiazides as the first-line treatment for individuals newly diagnosed with hypertension, a practice supported by good evidence and included in guidelines, and one which could reduce costs to the health care system.METHODS: The study uses a pragmatic, cluster randomized controlled trial (randomized by physician practice group).SETTING: The setting involves all Ontario general/family practice physicians. Messages advising the use of thiazides as the first-line treatment of hypertension were mailed to each physician in conjunction with a widely read professional newsletter. Physicians were randomized to receive differing versions of printed educational messages: an "insert" (two-page evidence-based article) and/or one of two different versions of an "outsert" (short, directive message stapled to the outside of the newsletter). One outsert was developed without an explicit theory and one with messages developed targeting factors from the theory of planned behaviour or neither (newsletter only, with no mention of thiazides). The percentage of patients aged over 65 and newly diagnosed with hypertension who were prescribed a thiazide as the sole initial prescription medication. The effect of the intervention was estimated using a logistic regression model estimated using generalized estimating equation methods to account for the clustering of patients within physician practices.RESULTS: Four thousand five hundred four physicians (with 23,508 patients) were randomized, providing 97 % power to detect a 5 % absolute increase in prescription of thiazides. No intervention effect was detected. Thiazides were prescribed to 27.6 % of the patients who saw control physicians, 27.4 % for the insert, 26.8 % for the outsert and 28.3 % of the patients who saw insert + outsert physicians, p = 0.54.CONCLUSIONS: The study conclusively failed to demonstrate any impact of the printed educational messages on increasing prescribing of thiazide diuretics for first-line management of hypertension.TRIAL REGISTRATION: ISRCTN72772651.

U2 - 10.1186/s13012-016-0486-3

DO - 10.1186/s13012-016-0486-3

M3 - Article

VL - 11

JO - Implementation Science

JF - Implementation Science

SN - 1748-5908

IS - 1

M1 - 124

ER -